Healthcare Provider Details

I. General information

NPI: 1841558723
Provider Name (Legal Business Name): PHILLIP MICHAELS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

BWH, 75 FRANCIS STREET
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 931-801-2510
  • Fax:
Mailing address:
  • Phone: 617-732-5500
  • Fax: 617-732-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number272305
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number272305
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: